June 30, 2015

Medicaid overbilling for provider lower than state originally claimed

A behavioral health provider had overbilling issues, but nowhere near the level the state originally claimed when it shut off Medicaid funding to the non-profit.

The Santa Fe New Mexican reported that Easter Seals El Mirador, a behavioral health provider had $127,240 in overbilling. The state originally accused the provider of $850,000 in overbilling.

The state cut off Medicaid funding from the provider, and more than a dozen others, when it found “credible allegations of fraud” in an audit of behavioral health providers according to then-Human Services Department Secretary Sidonie Squier. Easter Seals was cleared of fraud by the office of Attorney General Hector Balderas in January of this year.

The New Mexican reported on the latest news about the Santa Fe-area provider.

But Nancy Smith-Leslie, the Human Services Department Medicaid director, wrote in recent letter to Easter Seals officials that “based on the documentary evidence” and arguments presented during an administrative hearing this spring, “Easter Seals El Mirador was overpaid in the total amount of $127,240.40.”

Top officials from Easter Seals El Mirador said the Human Services Department arrived at the latest figure by extrapolating that total from evidence of roughly $691 worth of alleged billing errors in seven claims that the service provider submitted for Medicaid reimbursements from July 2009 to January 2013.

Smith-Leslie dated her letter June 24 — the two-year anniversary of the shake-up in which the Martinez administration called leaders of Easter Seals and 14 other behavioral health care providers to Santa Fe to tell them that “credible allegations” existed to show they had defrauded Medicaid out of $36 million over a three-year period.

State Rep. Bobby Gonzales shook his head from side to side after listening to all the suggestions about how to meet a judge's order to provide more resources to New Mexico children who, in the court's view, are not receiving a good public education. "About 15 different ideas," the Democrat from Taos said following a hearing on the topic last week in the House Appropriations and Finance Committee.

Even in his final days of battling leukemia in early 2016, Jose Frietze was fighting for the youth services agency he founded in 1977. The state Human Services Department had accused the organization — Las Cruces-based Families and Youth Inc. — of potential Medicaid fraud and overbilling by $856,745 in 2013.

Years after the state cut off Medicaid funding to 15 behavioral health providers, citing “credible allegations of fraud,” the Attorney General cleared all providers of the alleged fraud. AG Hector Balderas made finishing the investigation into the providers a key goal when he entered office in 2015.

Democrats swept statewide races on Election Day, and will control not just the governor’s office and all of the executive agencies, but also independent state agencies that oversee everything from state funds to state lands. Democratic incumbent Tim Eichenberg easily won the race for State Treasurer over Republican Arthur Castillo and Democrat Brian Colón defeated Republican Wayne Johnson for State Auditor.

Some vetoes by Gov. Susana Martinez are raising eyebrows among legislators and others—and at least one partial veto may be challenged in court. Wednesday was the final day for Martinez to decide whether or not to sign bills from this year’s legislative session.

State Rep. Bobby Gonzales shook his head from side to side after listening to all the suggestions about how to meet a judge's order to provide more resources to New Mexico children who, in the court's view, are not receiving a good public education.

Matthew Reichbach is the editor of the NM Political Report. The former founder and editor of the NM Telegram, Matthew was also a co-founder of New Mexico FBIHOP with his brother and one of the original hires at the groundbreaking website the New Mexico Independent. Matthew has covered events such as the Democratic National Convention and Netroots Nation and formerly published, “The Morning Word,” a daily political news summary for NM Telegram and the Santa Fe Reporter.
Matthew has appeared as a panelist for the Society of Professional Journalists’ New Mexico Chapter’s panel on covering New Mexico politics and the legislature.
A native New Mexican from Rio Rancho, Matthew’s family has been in New Mexico since the 1600s.